Line between taking medicine regularly and addiction?

Great Debates
1

As I age, I’m in the dilemma of trying to decide whether long-term use of mild stimulants like caffeine falls into the category of medicine or addiction. If I feel great when I first start taking something, eventually reach a plateau of diminished returns with regularly use, and suffer if I stop taking it, is that addiction? But couldn’t the same argument be made against anti-depressants? Or ultimately, food?

Many people live on daily intake of coffee, even though some people (and iirc the LDS church) regard it as an addiction. If smoking wasn’t harmful to the lungs, would anyone care if people remained permanently addicted to nicotine– as indeed seemed to be the custom for the first half of the 20th century? On the television series House, was Dr. House a drug addict or a chronic pain sufferer who really needed heavy pain relief?

Basically how do you judge whether you’re making up for a biological deficiency versus creating dependency?

2

Dr. House was obviously an addict.
Coffee? Not sure if one can be addicted. I drink it, but only with lots of mocha. Its the taste. Without mocha, I wouldnt want it.

3

It’s definitely physically addictive, in the sense that going without it can cause withdrawal symptoms, like headaches and drowsiness.

I used to hear about a distinction between “physically addictive” and “psychologically addictive,” but I don’t know what the current thinking is.

4

Physical addiction vs. habituation.

5

A professional definition of addiction:

While there are withdrawal-type symptoms (relatively short-lived in the case of coffee), coffee drinking and antidepressant use are not generally regarded as addictions. Users don’t typically experience uncontrollable cravings or ignore healthy self-care activities in order to partake.

“Gotta have my Paxil! I’ll rob and kill to get it!!!”

6

I consider myself addicted to caffeine. But addiction is a word with a lot of baggage. It’s more precise to say that I’m physically dependant on caffeine, and to add that that dependency is not harmful.

  • I function fine with the caffeine.
  • I enjoy the caffeine.
  • The long term health implications appear to be slightly positive.
  • I don’t need to increase the amount i consume, i am satisfied with a little less than i had yesterday.
  • When it is inconvenient to consume caffeine (mostly on Yom Kippur) i can’t stop cold turkey without unpleasant consequences, but i can taper down over 10 days with minimal problems.

Addictions are problematic when they interfere with other life functions and activities, when you can’t stop, and when the drug (or the way you take it) is harmful. None of those seems to be true of my caffeine addiction.

7

I think to be addicted to something, it should be a drug you didn’t originally need in the first place, and doesn’t address a medical issue.

So, if you never smoked before, and then you pick up your first cigarette, and before you know it you’re doing 2 packs a day, that’s addiction. But if someone with no heart conditions gets a disorder and needs a pill every morning for his heart, that’s not addiction, that’s medical treatment.

8

I suspect that a lot of opioid addictions wouldn’t meet your definition, when they originate from taking the drug because of a need (pain relief), and are drugs which do meet said medical issue.

9

Fair enough, I had not thought of that.

10

When it comes to things like opiates, a good guideline is that if you’re dependent on a medication, your quality of life will go up, and if you are addicted to a medication, it will go down. That’s VERY simplified, but it’s a good place to start.

Plus, while they’re using them, a person who is physically dependent but not addicted in the layperson’s sense will have no desire to take any more than they need, nor will they want to stay on it should the condition they’re using the meds to relieve goes away.

11

I teeter between dependent and addicted to opiates.

They are necessary. And I’m able to actually have a quality of life I would not otherwise have.

But…big one, the surgeon is soon (Tuesday)implanting a thingy in my abdomen that will hold my teeny tiny amount of drug, that will vastly decrease the amount I’m taking. With great pain relief. They say. (research looks positive)

I know how it feels when I get injections of opiates or take my pills.

I’m really afraid the psychological loss of that feeling of relief is gonna bother me. I’m scared. Because I will no longer have the pills or vial.

We’ll see what happens.

12

From my experience…

I’m 72 and take 3 tablets a day as recommended by my doctor.
I only take them because of medical advice and could easily stop. (I forgot one day and felt no cravings.)

I don’t drink coffee or tea.

I love chocolate :grinning: but can go a day or two without having any.

13

I admire Beck that you’re having a pump implanted. You’re taking a bold step.

14

My wife says she can’t function without it.
On the other hand, I’ll drink it if it’s on offer but when she was away visiting family recently I couldn’t be bothered to make any just for myself; I didn’t particularly miss it.

15

@Lumpy, if smoking wasn’t harmful to the lungs, I would still care if people smoke because I think it stinks and don’t care to be around it.

16

So let’s look at my caffeine use.

  • My quality of life using it is similar to my quality of life not using it (after a period of adjustment.)
  • I would like to take more. I really enjoy my morning cup of tea or coffee. More than i enjoy my afternoon cup of rooibos or decaf. I don’t take more because i know that i will regret it when i have trouble sleeping at night. I don’t take a second cup in the morning because if i do, I’ll miss it tomorrow.
  • I go off caffeine most years, for Yom Kippur. So far, I’ve always eventually picked up the habit again.

Yeah, some people seem not to become addicted to caffeine. I’m not one of them. I’m quite sensitive to caffeine in both directions. If i take more then ~ cup of coffee more than i had yesterday, i feel a little wired. If i cut back by more than ~ half of what i had yesterday, I’ll get headaches and feel sluggish. I sometimes overdose at a party (have a can of coke in the afternoon, for instance) because it’s fun, it my social drug of choice. But I’ll pay for it the next day. And if i just stop taking it, without carefully tapering off, I’ll get migraines and lack energy. My sister had to stop drinking coffee altogether because she got so sensitive that even minor fluctuations in how much she had when triggered migraines.

Anyway, an i addicted? Yes, i think so. But it’s a mild addiction that doesn’t interfere with enjoying life. It might even facilitate enjoying life. And a bunch of medical studies show the net effects on lifespan are small and probably slightly positive at the level i consume.

17

“Addict is such an ugly term. I prefer to refer to myself as a drug aficionado ….”

18

I heard somewhere that if it improves the quality of your life, it’s dependency. If it lowers the quality of your life, it’s addiction.

19

This is a great way to start a conversation with some people on the use of narcotic pain medication.
I had been prescribed narcotic pain medications beginning in the 1990s with darvocet when the use of massive ibuprofen products over a number of years ripped a hole in my stomach.
I was hit by a car and drug down the street when I was 3. Developed early onset arthritis symptoms in my teens. Bone spurs everywhere on my spine, scoliosis, stenosis, extra vertebrae somewhere in the mess.
I was on fentanyl patches from 2007 - early 2023. Doctor retired/insurance was bugging him to taper me off the meds.
The last couple years I have relied on intermittent prednisone/physical therapy and I am again taking massive doses of ibuprofen and sometimes acetaminophen just to take the edge off.
The patches gave me a good, predictable quality of life for many years and I am grateful for that.
Now I am referred to a pain clinic where I will give epidural cortisone shots a try. I am not a surgical candidate for various reasons.
All I know is that I am very reluctant to start up any kind of opiate medication again due to the stigma, scrutiny, and unpredictability of it all.
I will manage as well as I can until I feel I cannot take it any longer.

20

Disclaimer - I have one prescribed medication, a very light dose of trazadone as an off label sleep aid, and I often forget it, so I’m probably not the best to evaluate the risks and dependencies of prescription medicine.

But so far we’ve mostly been talking about either mostly mild/harmless addictions/dependencies (caffeine in it’s many forms), or the mostly serious/risky opiods. There’s also a lot of people using things, shall we say in the middle as official medicine or self medicating - things like alcohol and cannabis in various forms.

For the OP’s category of minor stimulants I think the risk and consequences are minimal. As a teenager and young adult, I certainly overdid it to the point of noticeable consequences upon cessation. About 2-3 days of painful headaches and 3-5 days of sleepiness are mild enough for me to not worry about that level of addiction because they’re low.

But more extreme stimulants (some of my parents friends on “weight loss drugs” that were basically caffeine and amphetamines) can be considered “medicine” but the consequences of addiction are much higher. You have to be able to trust your physician that they’re pushing you to use such things for legitimate reasons, and not to fill some quotas. And that they’re going to help you help yourself if you do move past dependency into addiction.

And the plethora of issues from anti-anxiety meds like diazepam, ADHD meds, painkillers, et al is yet another class of balancing risk vs quality of life.

Really again, it’s exactly the dilemma the OP suggests, because so many of the factors (across a wide range of medications and risks) aren’t easily quantifiable. QOL (quality of life) is very subjective - what is tolerable for one person is unbearable for others. Risk factors for addiction vary from the familial, to genetic, to early conditioning/exposure. Trust in our health services is understandably low after decades of profit taking, out-and-out pushing of known dangerous drugs, and disconnects between PCP and specialists.

This is one of those situations that really can’t be concluded in general, only in the specific in my experience.

But to do my best, I’ll head back to my earlier comments on advantages vs. risks. If the advantages are noticeable, and the risks minimal, I see little to no harm (caffeine). If the advantage is noticeable, and the risks are controllable and unlikely to have long term harm (cannabis in non-inhaled form) then that’s up to the person as long as they’re educated to said risks and it does no harm to others. Beyond that (alcohol and tobacco), we’re starting to get into much more noticeable heath risks and risks to others. And that’s where you want and need as much third party advice and pushback to make sure you’re not harming yourself and others.

[ no shade cast upon any and all participants or readers of the threads who are using and not abusing prescription drugs, recreational drugs, or tobacco and alcohol, as long as they’ve made a rational evaluation of the risks to self and others and taken steps to mitigate/remove them ]